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IGF-1 and IGFBP-3 screening for disorders of growth hormone secretion
R Rasat1, J L Livesey, E A Espiner
1Department of Endocrinology, Christchurch Hospital.
Insights
Plasma insulin-like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) assays are valuable for diagnosing growth hormone disorders. IGF-1 is key for adult growth hormone excess, while both aid in childhood deficiency screening.
Area of Science:
- Endocrinology
- Pediatric Endocrinology
- Clinical Diagnostics
Background:
- Growth hormone (GH) disorders impact development and metabolism.
- Accurate diagnosis relies on sensitive and specific biochemical markers.
- Insulin-like growth factor 1 (IGF-1) and IGF binding protein 3 (IGFBP-3) are key mediators of GH action.
Purpose of the Study:
- To evaluate the diagnostic utility of plasma IGF-1 and IGFBP-3 assays.
- To assess their role in identifying growth hormone disorders in children and adults.
- To compare assay performance against established reference ranges.
Main Methods:
- Plasma IGF-1 and IGFBP-3 levels were measured in pediatric and adult patient cohorts.
- Patients included those with short stature, hypopituitarism, and acromegaly.
- Results were compared to extensive normal pediatric and adult reference ranges.
Main Results:
- IGF-1 and IGFBP-3 levels show significant age-dependency in normal individuals.
- In short children, low IGF-1 and IGFBP-3 indicated growth hormone deficiency (GHd).
- IGF-1 was highly sensitive for acromegaly, while IGF-1 and IGFBP-3 aided GHd diagnosis in adults.
Conclusions:
- Age-adjusted IGF-1 and IGFBP-3 are effective screening tools for childhood GH deficiency.
- Plasma IGF-1 is the primary diagnostic marker for adult growth hormone excess (acromegaly).
- Low IGF-1 in adults with pituitary history suggests GH deficiency.
Aim:
To assess the value of plasma assays of insulin like growth factor (IGF-1) and insulin like growth factor binding protein 3 (IGFBP-3) in the diagnosis of growth hormone disorders in children and adults.
Methods:
Plasma IGF-1 and IGFBP-3 were measured in 47 children referred for the assessment of short stature, 26 adult subjects with hypopituitarism and in 10 adult subjects with acromegaly. Findings were compared with results obtained in 148 normal children and 124 normal adult subjects who comprised the reference range.
Results:
Levels of both growth factors and especially IGF-1 are highly age dependent in normal children and adults. Six of 47 short children had growth hormone deficiency and in these cases both IGF-1 and IGFBP-3 were close to the lower limit or below the normal reference range. In young children ( < 10 yr) IGFBP-3 was more informative than IGF-1, distinguishing normal short children from those with growth hormone deficiency. IGF-1 levels were raised in all 10 acromegalic adults, eight of whom had normal levels of IGFBP-3. Similarly growth hormone deficient adults were better identified (23 of 26 patients) by IGF-1 whereas IGFBP-3 was subnormal in only eight cases.
Conclusions:
Provided results are reviewed in relation to an age related normal reference range, both IGF-1 and IGFBP-3 are simple and convenient screening tests for assessing growth hormone deficiency in children. In adults plasma IGF-1 is the diagnostic test for a disorder of growth hormone excess. Low IGF-1 in an adult with a history of pituitary disease strongly suggests the presence of growth hormone deficiency.